Tags

Type your tag names separated by a space and hit enter

Preoperative contrast-enhanced computed tomographic characterisation of pancreatic cystic lesions: A prospective study.
SA J Radiol 2019; 23(1):1727SJ

Abstract

Background

Characterisation of pancreatic cystic lesions has a direct role in their management and computed tomography is the mainstay of investigation for diagnosing and characterising them.

Objectives

The aim of this study was to prospectively assess the diagnostic accuracy of contrast-enhanced computed tomography (CECT) in preoperative characterisation of pancreatic cystic lesions with histopathology as the reference standard.

Method

A total of 38 patients with cystic pancreatic lesions diagnosed after clinical, laboratory and sonographic evaluation, irrespective of age, were preoperatively evaluated with CECT. Images were reviewed for the general characteristics of the lesions on pre-contrast and portal venous phase images and overall diagnostic accuracy calculated. Imaging findings were compared with histopathology, or cytology and/or intra-operative findings.

Results

Serous cystadenoma (SCA) was the most common cystic pancreatic lesion found in 31.6% of patients followed by mucinous cystadenoma (MCA) (26.3%), solid pseudo-papillary tumour (SPT) (21.1%) and intra-ductal papillary mucinous neoplasm (IPMN) (10.5%). Three patients (7.9%) had simple cysts and one patient (2.6%) had a lymphangioma. The diagnostic accuracy of CECT for pancreatic cystic lesions was found to be 72.5.

Conclusion

The diagnostic accuracy of computed tomography (CT) was high for SCA, IPMN and pancreatic cysts, and low for MCA and SPT. Combination of a multiloculated cystic lesion with locule size of less than 20 mm, septal enhancement with relative lack of wall enhancement, central scar and lobulated outline are highly specific for SCA. Unilocular or macro-cystic pattern with locule size of more than 20 mm, female gender and wall enhancement with smooth external contour are pointers towards MCA. Solid cystic pancreatic head lesions in young females may be suggestive of SPT. A dilated main pancreatic duct in a cystic lesion with internal septations may point towards IPMN. Fluid attenuation lesions with imperceptible non-enhancing wall indicate pancreatic cysts. Lastly, pseudocysts and neuroendocrine tumours with cystic components are great mimickers of pancreatic cystic lesions, and a history of pancreatitis and hormonal profile of patients should always be sought.

Authors+Show Affiliations

Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India.Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India.Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India.Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India.Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India.Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India.Department of Surgical Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India.Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31754534

Citation

Saleem, Dar M., et al. "Preoperative Contrast-enhanced Computed Tomographic Characterisation of Pancreatic Cystic Lesions: a Prospective Study." SA Journal of Radiology, vol. 23, no. 1, 2019, p. 1727.
Saleem DM, Haseeb WA, Parry AH, et al. Preoperative contrast-enhanced computed tomographic characterisation of pancreatic cystic lesions: A prospective study. SA J Radiol. 2019;23(1):1727.
Saleem, D. M., Haseeb, W. A., Parry, A. H., Irfan, R., Muzaffar, N. M., Tariq, G., ... Feroz, I. (2019). Preoperative contrast-enhanced computed tomographic characterisation of pancreatic cystic lesions: A prospective study. SA Journal of Radiology, 23(1), p. 1727. doi:10.4102/sajr.v23i1.1727.
Saleem DM, et al. Preoperative Contrast-enhanced Computed Tomographic Characterisation of Pancreatic Cystic Lesions: a Prospective Study. SA J Radiol. 2019;23(1):1727. PubMed PMID: 31754534.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preoperative contrast-enhanced computed tomographic characterisation of pancreatic cystic lesions: A prospective study. AU - Saleem,Dar M, AU - Haseeb,Wani A, AU - Parry,Arshed H, AU - Irfan,Robbani, AU - Muzaffar,Najar M, AU - Tariq,Gojwari, AU - Javed,Shah O, AU - Feroz,Imza, Y1 - 2019/06/10/ PY - 2019/02/23/received PY - 2019/03/31/accepted PY - 2019/11/23/entrez PY - 2019/11/23/pubmed PY - 2019/11/23/medline KW - Serous cystadenoma KW - intra-ductal papillary mucinous neoplasm KW - mucinous cystadenoma KW - pancreatic lymphangioma KW - simple pancreatic cyst KW - solid pseudo-papillary tumour SP - 1727 EP - 1727 JF - SA journal of radiology JO - SA J Radiol VL - 23 IS - 1 N2 - Background: Characterisation of pancreatic cystic lesions has a direct role in their management and computed tomography is the mainstay of investigation for diagnosing and characterising them. Objectives: The aim of this study was to prospectively assess the diagnostic accuracy of contrast-enhanced computed tomography (CECT) in preoperative characterisation of pancreatic cystic lesions with histopathology as the reference standard. Method: A total of 38 patients with cystic pancreatic lesions diagnosed after clinical, laboratory and sonographic evaluation, irrespective of age, were preoperatively evaluated with CECT. Images were reviewed for the general characteristics of the lesions on pre-contrast and portal venous phase images and overall diagnostic accuracy calculated. Imaging findings were compared with histopathology, or cytology and/or intra-operative findings. Results: Serous cystadenoma (SCA) was the most common cystic pancreatic lesion found in 31.6% of patients followed by mucinous cystadenoma (MCA) (26.3%), solid pseudo-papillary tumour (SPT) (21.1%) and intra-ductal papillary mucinous neoplasm (IPMN) (10.5%). Three patients (7.9%) had simple cysts and one patient (2.6%) had a lymphangioma. The diagnostic accuracy of CECT for pancreatic cystic lesions was found to be 72.5. Conclusion: The diagnostic accuracy of computed tomography (CT) was high for SCA, IPMN and pancreatic cysts, and low for MCA and SPT. Combination of a multiloculated cystic lesion with locule size of less than 20 mm, septal enhancement with relative lack of wall enhancement, central scar and lobulated outline are highly specific for SCA. Unilocular or macro-cystic pattern with locule size of more than 20 mm, female gender and wall enhancement with smooth external contour are pointers towards MCA. Solid cystic pancreatic head lesions in young females may be suggestive of SPT. A dilated main pancreatic duct in a cystic lesion with internal septations may point towards IPMN. Fluid attenuation lesions with imperceptible non-enhancing wall indicate pancreatic cysts. Lastly, pseudocysts and neuroendocrine tumours with cystic components are great mimickers of pancreatic cystic lesions, and a history of pancreatitis and hormonal profile of patients should always be sought. SN - 1027-202X UR - https://www.unboundmedicine.com/medline/citation/31754534/Preoperative_contrast-enhanced_computed_tomographic_characterisation_of_pancreatic_cystic_lesions:_A_prospective_study L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31754534/ DB - PRIME DP - Unbound Medicine ER -